Standing Order for Primary & Community Health Care Bay of Plenty
Practice Name:
Practice Issue Date: Not valid after the review date: (one year after issue)
Medicine standing order for PARACETAMOL
Rationale
To support primary care and community vaccinators to provide paracetamol with Meningococcal B (Bexsero) immunisation event.
Bexsero immunisation commonly causes fever and injection site redness, swelling and or mild to moderate pain particularly in children aged less than 2 years of age
Routine use of paracetamol with every dose of Bexsero in children aged under 2 years, whether given alone or with other vaccines, is recommended to reduce the risk of high fever and injection site pain, as per datasheet. Some infants will still develop a fever and/or injection site pain even though they have received paracetamol doses.
Scope of use (the condition and patient group)
To administer and supply paracetamol Practitioner Supply Order (PSO) stock to patients < 2 years receiving Meningococcal B (Bexsero) vaccination in primary care and community settings.
Can also be used to administer and supply paracetamol PSO stock for children under 5 years receiving Bexsero vaccination, if required for symptom management, if they occur.
Medicine(s) Oral liquid 120mg/5ml
Route of administration Oral
Dosage range/ instructions
Three doses (see dosing according to today’s weight as below) of paracetamol are recommended as follows:
1. Registered Nurse (RN) to administer the first dose, up to 30 minutes prior to or at the time of Bexsero immunisation
2. Parents/caregivers should be instructed to give the second dose 6 hours after the first dose, and
3. The third dose should be given 6 hours after the second dose.
It is not necessary to wake a child to give paracetamol, just give it when they wake up as long as more than 6 hours have passed since the previous dose.
• Prematurely born infant less than 1 month corrected gestational age: Ensure current weight of the child is applied to dosage: 10 mg/kg as a single dose, every 6 hours up to a maximum 4 doses per day (total 3 doses only given specifically with or after vaccination)
• Child (1 month up to 2 years of age): Ensure a current weight of the child is applied to dosage: 15 mg/kg as a single dose every 6 hours up to a maximum 4 doses per day; (total 3 doses only given specifically with or after vaccination)
Exclusions/ contraindications and precautions for using this medication
Persons authorised to administer this standing order
Competency and training for the authorised person(s)
*Corrected gestational age
For example: A baby born at 30 weeks gestation (10 weeks early); baby is now 2 months old having Bexsero: 40 weeks minus 10 weeks plus 8 weeks = 38 weeks – this is less than 1-month CGA therefore use the preterm chart for dosing
Exclusions: (patients with the following are to be referred to medical practitioner for management)
• Children with fever
• Patients who have had a dose of paracetamol in the last 4 hours
• Children under 8 weeks of age because a prescription is required for Bexsero to be administered to these infants.
• Patients with hypersensitivity to paracetamol
• Patients who present with or have a history of renal or severe liver dysfunction Babies with jaundice must be urgently investigated
• Patients who are malnourished
• Children < 12 months of age in the PIPPA Tamariki Study. Check with parents as to which medication, either Paracetamol or Ibuprofen that the child is to be given. Parents will have a supply of the medication. If allocated to Ibuprofen then this should be used at the study dose and interval prescribed by the research clinicians.
A Registered Nurse (RN), working within , who is able to demonstrate a competency in working with this Standing Order.
Prior to administering Paracetamol under this Standing Order, RN staff are required to have:
• To have relevant training on providing oral medications to babies and children
• Reviewed the Health Navigator information on Paracetamol & literature available in different languages for parents
• A current BLS/ CPR certificate.
• An annual review of competency in administration of this Standing Order by the Issuer.
Monitoring: Countersign or audit
(please refer to the MOH 2016 Standing Order Guidelines
https://www.health.govt.nz/publication/standing-order- guidelines )
Option 1: Countersign If countersigning is the preferred option, the Issuer of the Standing Order is to specify the period which is required to be shorter than a month, e.g:
This standing order is to be countersigned by the Issuer of the Standing Order within [timeframe to be determined by the issuer e.g. 48 hours, 72 hours, 3 working days, 5 working days)
Option 2. Audit If auditing of the Standing Order is the preferred option, then the audit sample size as a minimum is to be used. The audit sample size as a minimum:
• 50 per cent of administration and/or supply records if there are 20 or fewer in total
• 20- 30 per cent of administration and/or supply records if they are in range of 21–100
• 15- 20 per cent of administration and/or supply records if there are over 100
If any administration and/or supply records found to be noncomplaint with the standing order, then the sample size is to be doubled.
The audit result is documented, along with any required changes or improvements in relation to the Standing Order documentation, processes or training undertaken.
Documentation and additional information
Under the Standing Order, the notifying RN documents in the PMS or clinical record the following:
• Current Health status
Weight
Corrected gestational age, if premature
Allergies
Presence or absence of contraindications as appropriate
Time and dose if paracetamol given within the last 24 hours.
• Adverse effects
• Parent/caregiver education provided
• Paracetamol should be supplied from pharmacy with a lock top lid and labelled with medicine name and strength. Document on the Paracetamol bottle label the date, the child’s name, and dose.
Definition
Mild-moderate pain Using the 0-10 pain scale or Wong Baker faces scale, 0-3 = mild pain, 4-6 = moderate pain
Reference Health Navigator: Paracetamol | Health Navigator NZ Starship Guidelines on Paracetamol (Oral/Rectal)
https://www.starship.org.nz/guidelines/paracetomol-oral-rectal/ Woods D (editor) New Zealand Formulary V62, August 2017.Available from www.nzf.org.nz
Issued by Name: NZMC#
Title:
Signature:
Date
Date:
RN Responsibilities
RNs named below agree to the following:
• Only RNs operating under standing orders from the named issuer can supply or administer the medication for the condition that has been assessed as appropriate by that RN
• The RN will ensure that they meet the regulatory requirements for an RN working under standing orders and must have:
• The competency and training to assess that the standing order applies to the presenting patient/client
• The competency to administer and/or supply the medicine
• The knowledge to assess the exclusions/contraindications and precautions
A register of the agreed standing order authorisations between the issuer and the registered nurse must be kept by the nurse and the issuer/practice and reviewed at least annually or when the issuer changes.
Document Control This standing order is valid until it is due to be reviewed OR Is replaced by a new Standing Order OR Cancelled by the issuer
Issue Date: 01 March 2023 Review Date: 01 March 2024
Approved by Metro Auckland Standing Order Steering Group modified from the Paracetamol SO for acute pain with content review and editing led by Dr Christine McIntosh Clinical Leader Immunisation Te Whatu Ora with IMAC, Immunisation teams and Northern Region Primary Care collaboration.